Ellyn Smith, DAB CR6604 (2025)

DECISION

Petitioner, Ellyn Smith, is a physician, practicing in California, who participates in the Medicare program as a supplier of services.  On February 9, 2024, she applied to reassign her Medicare benefits to Anaheim Surgical Associates, the group medical practice that employs her.  The Centers for Medicare & Medicaid Services (CMS) granted her application, with a “reassignment effective date” of January 10, 2024.  Petitioner now asks for an earlier date. 

Because she filed her subsequently-approved application on February 9, 2024, and a reassignment of benefits can be effective beginning 30 days before the application to reassign benefits (Form 855R) is submitted, January 10, 2024 is the correct effective date of reassignment. 

Background

In a notice letter, dated February 26, 2024, the Medicare contractor, Noridian Healthcare Solutions, advised Petitioner Smith that it approved her “Change of Information” application with a “reassignment effective date” of January 10, 2024.  CMS Ex. 2.  Petitioner requested reconsideration, asking that the date of reassignment be changed to May 10, 2023.  CMS Ex. 3.  In a reconsidered determination, dated August 13, 2024, the

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contractor affirmed the initial determination.  CMS Ex. 4.  Petitioner appealed, and the matter is now before me. 

Decision on the written record.  CMS has moved for summary judgment.  However, because neither party proposes any witnesses, an in-person hearing would serve no purpose.  See Acknowledgment and Prehearing Order at 4, 5, 6 (¶¶ 4(c)(iv), 8, 10) (August 23, 2024).  I may therefore decide this case based on the written record, without considering whether the standards for summary judgment are satisfied.  See Anil Hanuman, D.O., DAB No. 3080 at 12 (2022). 

CMS submits its motion and brief (CMS Br.) with eight exhibits (CMS Exs. 1-8).  In response, Petitioner resubmitted her March 6, 2024 request for reconsideration with no additional exhibits.  In the absence of any objections, I admit into evidence CMS Exhibits 1-8.  See Acknowledgment at 5 (¶ 7). 

Discussion

1. On February 9, 2024, Petitioner filed her subsequently-approved application to reassign benefits; her reassignment of benefits was therefore effective 30 days earlier – on January 10, 2024.  42 C.F.R. §§ 424.522(a).1

Enrollment.  Petitioner Smith participates in the Medicare program as a “supplier” of services.  Social Security Act § 1861(d); 42 C.F.R. § 498.2.  To receive Medicare payments for the services furnished to program beneficiaries, a prospective supplier must enroll in the program.  Act § 1834(j)(1)(A); 42 C.F.R. § 424.505.  “Enrollment” is the process by which CMS and its contractors: 1) identify the prospective supplier; 2) validate the supplier’s eligibility to provide items or services to Medicare beneficiaries; 3) identify and confirm a supplier’s owners and practice location; and 4) grant the supplier Medicare billing privileges. 42 C.F.R. § 424.502.  

To enroll, a prospective supplier must complete and submit an enrollment application.  42 C.F.R. §§ 424.510(d)(1), 424.515(a).  An enrollment application is either a CMS-approved paper application or an electronic process approved by the Office of Management and Budget.  42 C.F.R. § 424.502.2  When CMS determines that a prospective supplier meets the applicable enrollment requirements, it grants Medicare billing privileges, which means that the supplier can submit claims and receive payments from Medicare for covered services provided to program beneficiaries.  For a physician,

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the effective date for billing privileges “is the later of the date of filing” a subsequently-approved enrollment application or “the date that the supplier first began furnishing services at a new practice location.”  42 C.F.R. § 424.520(d) (emphasis added). 

A supplier may reassign her billing privileges under certain circumstances, including where the reassignment is to an employer or to a Medicare-enrolled entity pursuant to a contractual arrangement under which the entity bills for the supplier’s services.  42 C.F.R. § 424.80(b) and (d). 

Petitioner’s enrollment.  Here, on February 9, 2024, Petitioner filed, via the PECOS system, her application to reassign her Medicare benefits (CMS-855R), which the contractor subsequently approved.  CMS Ex. 1.  Thus, pursuant to section 424.520(d), the date Petitioner filed her subsequently-approved enrollment application – February 9, 2024 – is the correct effective date of enrollment.  Howard M. Sokoloff, DPM, MS, Inc., DAB No. 2972 (2019); Urology Grp. of NJ, LLC, DAB No. 2860 (2018); Willie Goffney, Jr., M.D., DAB No. 2763 at 7 (2017), aff’d Goffney v. Azar, No. CV 17-8032 MRW (C.D. Cal. Sept. 25, 2019).  

Pursuant to section 424.522(a), the reassignment of Petitioner’s benefits is effective beginning 30 days before she submitted Form CMS-855R – in this case, on January 10, 2024. 

Petitioner points out that she began providing services for the group practice on October 6, 2021, but the group’s enrollment – and the enrollment of its members – were later deactivated.  The practice group reapplied, and its enrollment became effective on May 10, 2023.  “Through an oversight,” she was not listed among the suppliers who would be reassigning benefits.  CMS Ex. 3.  Petitioner complains that she did not receive individual notice of the deactivation and asks for the May 10, 2023 effective date.  I have no authority to grant Petitioner the relief she requests.  The notice question she raises pertains to the deactivation of the group’s billing privileges.  No matter how compelling the circumstances, I have no authority to review a deactivation.  Ark Health Grp., DAB No. 2929 at 7-9 (and cases cited therein).  Nor may I grant Petitioner relief based on her equitable arguments.  Sokoloff, DAB No. 2972 at 9. 

Conclusion

On February 9, 2024, Petitioner filed her subsequently-approved application to reassign Medicare benefits.  Pursuant to 42 C.F.R. § 424.522(a), the reassignment was effective 30 days earlier – on January 10, 2024.